EP1066807B1 - Handgelenkprothese - Google Patents

Handgelenkprothese Download PDF

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Publication number
EP1066807B1
EP1066807B1 EP99112951A EP99112951A EP1066807B1 EP 1066807 B1 EP1066807 B1 EP 1066807B1 EP 99112951 A EP99112951 A EP 99112951A EP 99112951 A EP99112951 A EP 99112951A EP 1066807 B1 EP1066807 B1 EP 1066807B1
Authority
EP
European Patent Office
Prior art keywords
prosthesis according
wrist prosthesis
wrist
bearing
ulna
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Lifetime
Application number
EP99112951A
Other languages
German (de)
English (en)
French (fr)
Other versions
EP1066807A1 (de
Inventor
Peter C.G. Hubach
Bernd Schäfer
Thilo Trautwein
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Individual
Original Assignee
Individual
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority to DE19820015A priority Critical patent/DE19820015C2/de
Application filed by Individual filed Critical Individual
Priority to ES99112951T priority patent/ES2216383T3/es
Priority to EP99112951A priority patent/EP1066807B1/de
Priority to DE59908812T priority patent/DE59908812D1/de
Priority to AT99112951T priority patent/ATE261284T1/de
Priority to US09/347,924 priority patent/US6485520B1/en
Publication of EP1066807A1 publication Critical patent/EP1066807A1/de
Application granted granted Critical
Publication of EP1066807B1 publication Critical patent/EP1066807B1/de
Anticipated expiration legal-status Critical
Expired - Lifetime legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
    • A61F2/4261—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for wrists
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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A—HUMAN NECESSITIES
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    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8033—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers
    • A61B17/8047—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers wherein the additional element surrounds the screw head in the plate hole
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    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
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    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
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    • A61F2002/30362—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit with possibility of relative movement between the protrusion and the recess
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Definitions

  • the invention relates to a wrist prosthesis with the Features of the preamble of claim 1.
  • a wrist prosthesis is known from US Pat. No. 5,458,646 which is a first, proximal section with the distal end of the Spoke and the distal end of the ulna is rigidly connected.
  • a distal section of the prosthetic wrist is attached to the Wrist bone connected.
  • This second, distal section the wrist prosthesis has a rounded, proximal one End, which is on a straight surface of the proximal section is applied.
  • Such a wrist prosthesis has several Disadvantage. First, it connects the spoke with the ulna rigid what a movement of the wrist in pro and Direction of supination restricted. On the other hand, it is Connection of the distal section of the wrist prosthesis with insufficient for the carpal bone. After all, one is such a wrist prosthesis only at not far advanced osteoporosis and therefore only of limited use or applicable.
  • the invention is therefore based on the object To provide wrist prosthesis that is a wider Has area of application.
  • the wrist prosthesis according to the invention can advantageously used in rheumatoid arthritis.
  • she has the main advantage that the proximal section is only rigidly connected to the spoke. Serves for this a single anchor cemented into the spoke, the is inserted relatively far into the spoke.
  • the second, distal section of the prosthesis with at least one, connected to two metacarpal bones in particular, whereby achieved much better stability and anchoring becomes.
  • screws are used, which are in the metacarpals be screwed in.
  • the screws have a relative long, unthreaded screw tip at the front end is rounded.
  • the relatively long screw makes one secure connection of the distal section to the bones guaranteed.
  • the two sections point each have a part of a curved bearing, whereby a optimal support both in the axial direction and in all transverse directions are guaranteed.
  • the curved one Bearings have a bearing part facing the spoke and a bearing element facing the metacarpal bones, the bearing part being convex and the bearing element concave is curved and the curvatures are part-circular.
  • the anchor is preferably asymmetrically shaped and has an anchor head protruding beyond the spoke. This The anchor head forms part of the curved bearing.
  • the distal Section has a carpal plate in which the Connecting elements to the hand bones, in particular Bone screws are stored.
  • the wrist plate points Recordings for the screw heads.
  • the receptacles for the screws have the shape an eight on.
  • different positions of the Screw head possible, and the distance between the screws is adjustable to each other.
  • the axes of the recordings in the plane of inclination of the wrist at an angle of 5 ° to 15 °, in particular Is inclined at 12 ° to the axis of the proximal section. So the wrist is at an angle in the range of 5 ° to 15 ° inclined, this inclination the basic position represents.
  • the wrist root plate is preferably provided with a bearing element connected to the proximal section.
  • This bearing element points the other part of the curved bearing and can in relation can be adjusted to the size of the wrist.
  • the bearing element is e.g. with a Screw connection connected to the carpal plate or that Bearing element has a dovetail connection, via which is connected to the wrist plate.
  • the Dovetail connection can be made with a snap-snap connection be provided so that the coupling of the Bearing element to the wrist plate quickly and above all is possible without tools.
  • a preferred embodiment provides that the Bearing element is provided with a pin that fits into a groove engages the anchor head, or vice versa, causing the bearing is stabilized with respect to the direction of procination and supination, the inclination of the bearing remains unaffected.
  • the anchor head of the anchor is on its side facing the mandrel for receiving an ell-spoke connecting means, especially an elbow plate, is trained. If necessary, the anchor can be used with this Be placed on the elbow plate, with a The spoke can be connected to the ulna. This Connection is made by the fact that the elbow plate is the anchor head of the anchor protrudes laterally and a receptacle for one Elbow screw, which in the end of the ulna is screwed in.
  • the elbow screw is used in relation to the elbow plate pivoted and / or axially displaceable.
  • This Movable storage additionally allows a relative unobstructed wrist rotation, despite the relative great freedom of the cubit, this is still supported.
  • Wear-resistant storage is achieved in that the Bearing element and / or the insert made of plastic, in particular are made of polyethylene.
  • the other components can Steel, in particular made of titanium, the surface is provided with a coating that prevents the Bones supported.
  • a coating is e.g. under the name HA (hydroxy appetite) coating known.
  • the individual modules can be selected and assembled during the operation. This can e.g. different thickness and / or bone screws of different lengths, different sizes Wrist root plates, bearing elements of different sizes, different sized elbows and different thicknesses and long anchors and different sized elbows his.
  • This wrist prosthesis 1 is a particularly preferred one Embodiment of an overall designated 1 Wrist prosthesis shown.
  • This wrist prosthesis 1 has a first, proximal section 2 and a second, distal section 3.
  • the two sections 2 and 3 are via a curved bearing 4, which is shown in FIGS is more recognizable, articulated together.
  • the proximal section 2 has an anchor 5, which in the Individual is shown in Figure 4.
  • the anchor 5 is with an asymmetrically designed mandrel 6, the Pronation side 7 curved and the supination side 8 straight is trained.
  • the mandrel 6 has a rounded tip and expands towards his anchor head 9. This one
  • the anchor head 9 has two threaded holes on its underside 10 and 11, which are arranged on both sides of the mandrel 8.
  • the Threaded holes 10 and 11 and the mandrel 6 are in one provided on the underside of the anchor head 9 Deepening 12.
  • the deepening 12 has the task of Cement the anchor 5 in the spoke of a forearm absorb excess cement.
  • the 6th opposite side of the anchor head 9 forms a part 13 of the curved bearing 4, this bearing part 13 both in Longitudinal direction (arrow 14) and transverse direction (arrow 15) is designed in the form of a partial arc, the radius in Longitudinal direction is greater than the radius in the transverse direction.
  • FIG. 5 shows a second exemplary embodiment of an armature 5 shown, the anchor head 9 with a in the transverse direction 15th extending groove 16 is provided.
  • the function of the groove 16 is explained below in the discussion of FIG. 15.
  • FIG 6 shows an elbow plate 17, which is also in the figures 1 to 3 is recognizable.
  • the elbow plate 17 is about screws 18, the screw head are in countersunk openings 19, with the Underside of the anchor head 9, in particular with the Threaded holes 10 and 11 screwed.
  • the elbow plate 17 also has a recess 20 for receiving excess cement is used. Through the elongated opening 21 the mandrel 6 is guided through the plate 17.
  • the elbow plate 17 projects beyond the anchor head 9 with a Section 22 which, as shown ( Figures 1 to 3 and 6) in is the same level of the elbow plate 17, but at other embodiments (not shown) down, i.e. can be bent in the direction of the mandrel 6.
  • the opening 21 and section 22 are then in two to each other spaced and parallel planes. However, it is also conceivable, the section 22 angled relative to the opening 21 embody.
  • the section 22 has an opening 23 into which a Insert 24 is clipped.
  • This insert 24 is in the Figures 7 and 8 shown.
  • This insert 24 forms a Bearing for the pin-like head 25 of an elbow screw 26 ( Figure 9).
  • the insert 24 has a circumferential shoulder 27, with which he on the underside ( Figure 6) of the Ellenplatte 17th is applied.
  • Four grip on the top of the elbow plate 17 elastically resilient hook elements 28, which the Form the end of a sleeve-shaped central part 29.
  • This Sleeve part 29, the end of which is provided with four slots 30, whereby the hook elements 28 are formed has one Inner surface facing in the direction of the axis 31 of the insert 24 is so curved that the opening cross section of the respective ends of the insert 24 in the direction of the center decreases.
  • This insert 24 is preferably made from a plastic, in particular from polyethylene.
  • the elbow screw 26 shown in FIG. 9 has one unthreaded tip 32, a threaded portion 33, a Hexagon 34 and the circular cylindrical screw head 25.
  • the tip 32 is rounded at its free end and goes conical in the threaded portion 33.
  • the Threaded section 33 is also conical.
  • the elbow screw 26 can in a cubit be screwed in axially, the head of which has been removed.
  • the circular cylindrical screw head 25 is in use 24 stored and there both axially in the direction of the axis 31 moved as well as around the center of the insert 24 be pivoted.
  • the elbow screw 26 um whose longitudinal axis is rotated in the insert 24.
  • FIG. 10 shows a carpal plate 35 in perspective view, in particular one Dovetail groove 36 and two receptacles 37 and 38 and one Part of a snap-snap connection 39 can be seen.
  • the heads 40 of two bone screws 41 can be used.
  • Recordings 37 and 38 are used for this dome-shaped, the screw head 40 the Has the shape of a spherical section.
  • Bone screws 41 corresponding to the elbow screw 26 educated. Through the conical screw tip, the is thread-free, the screw 41 at Screwed into the metacarpals optimally guided.
  • To the Screwing in a hexagon tool is used, which with the hexagon opening 42 in the screw head 40 of the Bone screw 41 interacts.
  • the recordings 37 and 38 have the shape of an eight, which creates the possibility that the Bone screws 41 in each receptacle 37 and 38 in two Position can be arranged. In this way, the Distance between the bone screws 41 and the location of the Bone screws 41 with respect to the carpal plate 35 and thus be optimally set with regard to the spoke.
  • the wrist plate 35 is a Has wedge shape
  • Dovetail groove 36 having base is inclined.
  • the angle of inclination is 12 °.
  • the dovetail groove 36 on one inclined base surface is provided so that the axis of the Recordings 37 and 38 are orthogonal to the exit surface.
  • Figures 13 and 14 show a first embodiment a bearing element 43, which has a dovetail spring 47 has that to the dovetail groove 36 of the carpal plate 35 corresponds.
  • the top 44 has one resilient tongue 45, of which a pin 46 projects. If the bearing element 43 on the Dovetail joints 36 and 47 with the carpal plate 35 connected, then we the pin 46 on the inlet slope 48 of the snap-lock connection 39 pressed. Is this Bearing element 43 completely into the wristplate 35 inserted, then the pin 46 snaps into the groove 49 of the Wrist plate 35 and the bearing element 43 captively attached to the carpal plate 35.
  • the Bearing element 43 preferably consists of a plastic, especially made of polyethylene.
  • the side opposite the dovetail spring 47 is concave and has both in the longitudinal direction (arrow 14) as well as in the transverse direction (arrow 15) semi-circular curvature inwards, the radius in The longitudinal direction is larger than the radius in the transverse direction.
  • the bearing element 43 has one on a narrow side Recess 50 ( Figures 3, 13 and 14) which ensures is that the bearing element 43 when pivoting in Longitudinal direction (supination) not with the head 25 of the Elbow screw 26 collides.
  • FIG. 15 shows a second embodiment of the Bearing element 43, which on the second part 51 of the Bearing 4 forming concave surface carries a pin 52, that projects axially.
  • This pin 52 engages in the Figure 5 shown groove 16 of the anchor head 9.
  • This pin 52 becomes a movement of the bearing 4 in Longitudinal direction (arrow 14) (pronation and supination) prevented, whereas an inclination in the transverse direction (arrow 15) continues before is possible. This is how the prosthetic wrist stabilized in one direction.
  • the individual components aside from the elements about which they interact with each other connected can have different sizes. So can e.g. the screws 26 and 41 of different lengths and have a different cross-section, the Bearing element 43 can be equipped with different heights be, the elbow plate 17 may be flat or curved the laterally projecting section 22 can project to different degrees.
  • the anchor can also 5 different sizes.
  • Another advantage of the invention is that the Wrist prosthesis both with and without an elbow plate 17 can be used.

Landscapes

  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)
  • Surgical Instruments (AREA)
EP99112951A 1998-05-06 1999-07-05 Handgelenkprothese Expired - Lifetime EP1066807B1 (de)

Priority Applications (6)

Application Number Priority Date Filing Date Title
DE19820015A DE19820015C2 (de) 1998-05-06 1998-05-06 Handgelenkprothese
ES99112951T ES2216383T3 (es) 1998-05-06 1999-07-05 Protesis de muñeca.
EP99112951A EP1066807B1 (de) 1998-05-06 1999-07-05 Handgelenkprothese
DE59908812T DE59908812D1 (de) 1998-05-06 1999-07-05 Handgelenkprothese
AT99112951T ATE261284T1 (de) 1998-05-06 1999-07-05 Handgelenkprothese
US09/347,924 US6485520B1 (en) 1998-05-06 1999-07-06 Wrist prosthesis

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
DE19820015A DE19820015C2 (de) 1998-05-06 1998-05-06 Handgelenkprothese
EP99112951A EP1066807B1 (de) 1998-05-06 1999-07-05 Handgelenkprothese
US09/347,924 US6485520B1 (en) 1998-05-06 1999-07-06 Wrist prosthesis

Publications (2)

Publication Number Publication Date
EP1066807A1 EP1066807A1 (de) 2001-01-10
EP1066807B1 true EP1066807B1 (de) 2004-03-10

Family

ID=27218348

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EP99112951A Expired - Lifetime EP1066807B1 (de) 1998-05-06 1999-07-05 Handgelenkprothese

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US (1) US6485520B1 (es)
EP (1) EP1066807B1 (es)
AT (1) ATE261284T1 (es)
DE (2) DE19820015C2 (es)
ES (1) ES2216383T3 (es)

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Also Published As

Publication number Publication date
US6485520B1 (en) 2002-11-26
ES2216383T3 (es) 2004-10-16
EP1066807A1 (de) 2001-01-10
DE59908812D1 (de) 2004-04-15
ATE261284T1 (de) 2004-03-15
DE19820015C2 (de) 2000-09-07
DE19820015A1 (de) 1999-12-09

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